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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT. ---------------- -- A, (Complete in Triplicate) Permit No: ---------------------------------------------------------- This Permit Expires ] Year From Date issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: 01 J& JOB ADDRESS/LOC ATI N .-- - --- -------4„��-----. _--�P/�-------- ----------CENSUS TRACT -----.--------.------•__._ Owner's Name ` '' ------------------------------------------- Phone _ :� � ---------- - 47YAddress .. ---------------------------------- ------------------------------------------- City ---� M - •---- ------- Contractor's Name _b .__ ____S,�0,0 ------,_ c'-------- -------License #4�77rIC_ Phone Installation will serve: Residence;AApartment House❑ Commercial ❑Trailer Court Motel ❑ Other --------- ---------------------------------- Number of living units:----/----- Number of bedrooms .,- Z---Garbage Grinder -//V- O-- Lot Size -/'00~-- Water Supply: Public System and name _________________ ________________Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam;❑ 1 Hardpan ❑ AdobeA Fill Material ------------ If yes, type --------------------------- (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) 0 NEW INSTALLATION: 1No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TAN Size__ , "'------------ Liquid Depth ��________ _______ Capacity Typ __- Materi ° No. Compartments ----------------- Distance to nearest: Wel _-- ---------------------Foundation ----------------- Prop. line , ------ LEACHING ____LEACHING LINE . f 4 No. of Lines -------2_`----- ____ Length of each line---- - ._____ Total Length .__ ________________ # - ;e D' Box _- Type'Filter Material Depth Filter Material __J ____________________________ ___ 1 Distan a to nearest: Well ___________ --__ Foundation _.4____________.______-- Property Line. _._.____._________._.... SEEPAGE PIT I Depth ,ar. .�----- Diameter 34K-----i Number ____�._ ___ __________ft __ Rock Filled Yew No .i❑ 1 Water Table Depth -------------------------------Rock Size:__/ , ----------------- Distance ---------------Distance to nearest: Well ____ _ _ _�_ -------------------Foundation !jo- -____ Prop. Line _.__ REPAIR/ADDITION (Prev.(Prey. Sanitation Permit# -------•.----------------------------------- Date ------.----_----------------------J Septic Tank {Specify Requirements) ----------- --------------------------------------------------------------------- ------ ---._---------------------------- DisposalField (Specify Requirements) ---------------------------------------------------------------------------------------------------------------------•---•----------- --------------------------------- --------------------------------------------------------------------------------------- ' (Draw existing and required addition on reverse side) > I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: •` -1"1 certify that in t e performance of the work�for which this permit is issued, I shall not employ any person in such manner as to/mect to W r an' mpensation laws of California." Signe - " - - ---- ------------ -----. Owner 1 Title r an owner) FOR DEPARTMENT-USE ONLY APPLICATION ACCEPTED BY _D - ------------------------ ---- ----------------�-------- - -----. DATE ...�—�r��-�..------------------ SUED BUILDING PERMIT COMMENTS ------ -------------------------------------=--------------------------------------------------" DATE ------------------------------------------- ADDITIONALCOMMENTS ---- --------------------------------------------------------- ----------------------------------------------------- --------------------------- - - -------- -------- ---- - - ----- - ------ ----- --- - --- ---- - - - - - -_� __ --- ------------------------------ ------ -- - ----- -------------- ------ - - Final-Ins- -.-c. ionb-- - - -----_----- -------------------------------------------------------------------------------------------- ---------------=------- ----- Date --------------------------------- - -------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. SM ��